Encounters with Rheumatologists in a Publicly Funded Canadian Healthcare System: A Population-based Study

Objective.To quantify population-level and practice-level encounters with rheumatologists over time.Methods.We conducted a population-based study from 2000 to 2015 in Ontario, Canada, where all residents are covered by a single-payer healthcare system. Annual total number of unique patients seen by rheumatologists, the number of new patients seen, and total number of encounters with rheumatologists were identified.Results.From 2000 to 2015, the percentage of the population seen by rheumatologists was constant over time (2.7%). During this time, Ontario had a stable supply of rheumatologists (0.8 full-time equivalents/75,000). From 2000 to 2015, the number of annual rheumatology encounters increased from 561,452 to 786,061, but the adjusted encounter rates remained stable over time (at 62 encounters per 1000 population). New patient assessment rates declined over time from 10 new outpatient assessments per 1000 in 2000 to 6 per 1000 in 2015. The crude volume of new patients seen annually decreased and an increasing proportion of rheumatology encounters were with established patients. We observed a shift in patient case mix over time, with more assessments for systemic inflammatory conditions. Rheumatologists’ practice volumes, practice sizes, and the annual number of days providing clinical care decreased over time.Conclusion.Over a 15-year period, the annual percentage of the population seen by a rheumatologist remained constant and the volume of new patients decreased, while followup patient encounters increased. Patient encounters per rheumatologist decreased over time. Our findings provide novel information for rheumatology workforce planning. Factors affecting clinical activity warrant further research.

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Feminization of the rheumatology workforce: A longitudinal evaluation of patient volumes, practice sizes and physician remuneration

The Journal of Rheumatology ◽

10.3899/jrheum.201166 ◽

2020 ◽

pp. jrheum.201166

Author(s):

Jessica Widdifield ◽

Jodi M. Gatley ◽

Janet E. Pope ◽

Claire E.H. Barber ◽

Bindee Kuriya ◽

...

Keyword(s):

Workforce Planning ◽

Population Based ◽

Annual Number ◽

Clinical Activity ◽

Full Time ◽

Fee For Service ◽

Population Based Study ◽

Male And Female ◽

Practice Size ◽

Physician Remuneration

Objective To compare differences in clinical activity and remuneration between male and female rheumatologists and to evaluate associations between physician gender and practice sizes and patient volume, accounting for rheumatologists’ age, and calendar year effects. Methods We conducted a population-based study in Ontario, Canada between 2000-2015 identifying all rheumatologists practicing as full-time equivalents (FTE) or above and assessed differences in practice sizes (number of unique patients), practice volumes (number of patient visits), and remuneration (total fee-for-service billings) between male and female rheumatologists. Multivariable linear regression was used to evaluate the effects of gender on practice size and volume separately, accounting for age and year. Results The number of rheumatologists practicing at or above one FTE increased from 89 to 120 from 2000 to 2015, with the percentage of females increasing from 27.0% to 41.7%. Males had larger practice sizes and practice volumes. Remuneration was consistently higher for males (between $46,000-$102,000 annually). Our adjusted analyses estimated that in a given year, males saw a mean of 606 (95% CI 107-1105) more patients than females did, and had 1,059 (95% CI 345- 1773) more patient visits. Among males and females combined, there was a small but statistically significant reduction in mean annual number of patient visits, and middle-aged rheumatologists had greater practice sizes and volumes than their younger/older counterparts. Conclusion On average, female rheumatologists saw fewer patients and had fewer patient visits annually relative to males, resulting in lower earnings. Increasing feminization necessitates workforce planning to ensure that populations’ needs are met.

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Did the addition of concomitant chemotherapy to radiotherapy improve outcomes in hypopharyngeal cancer? A population-based study

Current Oncology ◽

10.3747/co.23.3085 ◽

2016 ◽

Vol 23 (4) ◽

pp. 266 ◽

Cited By ~ 8

Author(s):

S.F. Hall ◽

R. Griffiths

Keyword(s):

Overall Survival ◽

Head And Neck ◽

Treatment Options ◽

Population Level ◽

Population Based ◽

Hypopharyngeal Cancer ◽

Concurrent Chemotherapy ◽

Population Based Study ◽

Clinical Trial Evidence ◽

Over Time

BackgroundFor oncologists and for patients, no site-specific clinical trial evidence has emerged for the use of concurrent chemotherapy with radiotherapy (ccrt) over radiotherapy (rt) alone for cancer of the hypopharynx (hpc) or for other human papilloma virus–negative head-and-neck cancers.Methods This retrospective population-based cohort study using administrative data compared treatments over time (1990–2000 vs. 2000–2010), treatment outcomes, and outcomes over time in 1333 cases of hpc diagnosed in Ontario between January 1990 and December 2010.Results The incidence of hpc is declining; the use of ccrt that began in 2001 is increasing; and the 3-year overall survival for all patients remains poor at 34.6%. No difference in overall survival was observed in a comparison of patients treated in the decade before ccrt and of patients treated in the decade during the uptake of ccrt.Conclusions The addition of ccrt to the armamentarium of treatment options for oncologists treating head-and neck patients did not improve outcomes for hpc at the population level.

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OP0248 PREMATURE MORTALITY BURDEN FOR SYSTEMIC SCLEROSIS: NATIONWIDE POPULATION-BASED STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2270 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 156.1-156

Author(s):

E. Yen ◽

D. Singh ◽

M. Wu ◽

R. Singh

Keyword(s):

Rheumatoid Arthritis ◽

United States ◽

Disease Burden ◽

Age Groups ◽

Premature Mortality ◽

Population Based ◽

Age Group ◽

Population Based Study ◽

Mortality Burden ◽

Over Time

Background:Premature mortality is an important way to quantify disease burden. Patients with systemic sclerosis (SSc) can die prematurely of disease, however, the premature mortality burden of SSc is unknown. The years of potential life lost (YPLL), in addition to age-standardized mortality rate (ASMR) in younger ages, can be used as measures of premature death.Objectives:To evaluate the premature mortality burden of SSc by calculating: 1) the proportions of SSc deaths as compared to deaths from all other causes (non-SSc) by age groups over time, 2) ASMR for SSc relative to non-SSc-ASMR by age groups over time, and 3) the YPLL for SSc relative to other autoimmune diseases.Methods:This is a population-based study using a national mortality database of all United States residents from 1968 through 2015, with SSc recorded as the underlying cause of death in 46,798 deaths. First, we calculated the proportions of deaths for SSc and non-SSc by age groups for each of 48 years and performed joinpoint regression trend analysis1to estimate annual percent change (APC) and average APC (AAPC) in the proportion of deaths by age. Second, we calculated ASMR for SSc and non-SSc causes and ratio of SSc-ASMR to non-SSc-ASMR by age groups for each of 48 years, and performed joinpoint analysis to estimate APC and AAPC for these measures (SSc-ASMR, non-SSc-ASMR, and SSc-ASMR/non-SSc-ASMR ratio) by age. Third, to calculate YPLL, each decedent’s age at death from a specific disease was subtracted from an arbitrary age limit of 75 years for years 2000 to 2015. The years of life lost were then added together to yield the total YPLL for each of 13 preselected autoimmune diseases.Results:23.4% of all SSc deaths as compared to 13.5% of non-SSc deaths occurred at <45 years age in 1968 (p<0.001, Chi-square test). In this age group, the proportion of annual deaths decreased more for SSc than for non-SSc causes: from 23.4% in 1968 to 5.7% in 2015 at an AAPC of -2.2% (95% CI, -2.4% to -2.0%) for SSc, and from 13.5% to 6.9% at an AAPC of -1.5% (95% CI, -1.9% to -1.1%) for non-SSc. Thus, in 2015, the proportion of SSc and non-SSc deaths at <45 year age was no longer significantly different. Consistently, SSc-ASMR decreased from 1.0 (95% CI, 0.8 to 1.2) in 1968 to 0.4 (95% CI, 0.3 to 0.5) per million persons in 2015, a cumulative decrease of 60% at an AAPC of -1.9% (95% CI, -2.5% to -1.2%) in <45 years old. The ratio of SSc-ASMR to non-SSc-ASMR also decreased in this age group (cumulative -20%, AAPC -0.3%). In <45 years old, the YPLL for SSc was 65.2 thousand years as compared to 43.2 thousand years for rheumatoid arthritis, 18.1 thousand years for dermatomyositis,146.8 thousand years for myocarditis, and 241 thousand years for type 1 diabetes.Conclusion:Mortality at younger ages (<45 years) has decreased at a higher pace for SSc than from all other causes in the United States over a 48-year period. However, SSc accounted for more years of potential life lost than rheumatoid arthritis and dermatomyositis combined. These data warrant further studies on SSc disease burden, which can be used to develop and prioritize public health programs, assess performance of changes in treatment, identify high-risk populations, and set research priorities and funding.References:[1]Yen EY….Singh RR. Ann Int Med 2017;167:777-785.Disclosure of Interests:None declared

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Humidifier Disinfectant Consumption and Humidifier Disinfectant-Associated Lung Injury in South Korea: A Nationwide Population-Based Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116136 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6136

Author(s):

Jeonggyo Yoon ◽

Minsun Kang ◽

Jaehun Jung ◽

Min Jae Ju ◽

Sung Hwan Jeong ◽

...

Keyword(s):

Health Insurance ◽

Lung Injury ◽

National Health Insurance ◽

Population Based ◽

Annual Number ◽

Population Based Study ◽

Annual Consumption ◽

Using Data ◽

Water Tanks ◽

Biocidal Product

Humidifier disinfectant (HD) is a household biocidal product used in humidifier water tanks to prevent the growth of microorganisms. In 2011, a series of lung injury cases of unknown causes emerged in children and pregnant women who had used HD in Korea. This study investigated changes in the nationwide number of cases of humidifier disinfectant-associated lung injury (HDLI) in concordance with nationwide HD consumption using data covering the entire Korean population. More than 25 kinds of HD products were sold between 1994 and 2011. The number of diagnosed HDLI, assessed by S27.3 (other injuries of lungs) of the Korea National Health Insurance Service (NHIS) data, sharply increased by 2005, subsequently decreased after 2005, and almost disappeared after 2011 in concordance with the annual number of HD sales. The number of self-reported HDLIs, assessed using data from all suspected HDLI cases registered in the Korea Ministry of Environment, changed with the annual number of HD sales, with a delay pattern, potentially induced by the late awareness of lung injury diseases. The present study suggests that changes in the nationwide annual consumption of HD products were consistent with changes in the annual number of HDLI cases in Korea.

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Patterns of Survival Among Patients With Myeloproliferative Neoplasms Diagnosed in Sweden From 1973 to 2008: A Population-Based Study

Journal of Clinical Oncology ◽

10.1200/jco.2012.42.1925 ◽

2012 ◽

Vol 30 (24) ◽

pp. 2995-3001 ◽

Cited By ~ 112

Author(s):

Malin Hultcrantz ◽

Sigurdur Yngvi Kristinsson ◽

Therese M.-L. Andersson ◽

Ola Landgren ◽

Sandra Eloranta ◽

...

Keyword(s):

General Population ◽

Life Expectancy ◽

Excess Mortality ◽

Myeloproliferative Neoplasms ◽

Treatment Options ◽

Large Population ◽

Relative Survival ◽

Population Based ◽

Population Based Study ◽

Over Time

PurposeReported survival in patients with myeloproliferative neoplasms (MPNs) shows great variation. Patients with primary myelofibrosis (PMF) have substantially reduced life expectancy, whereas patients with polycythemia vera (PV) and essential thrombocythemia (ET) have moderately reduced survival in most, but not all, studies. We conducted a large population-based study to establish patterns of survival in more than 9,000 patients with MPNs.Patients and MethodsWe identified 9,384 patients with MPNs (from the Swedish Cancer Register) diagnosed from 1973 to 2008 (divided into four calendar periods) with follow-up to 2009. Relative survival ratios (RSRs) and excess mortality rate ratios were computed as measures of survival.ResultsPatient survival was considerably lower in all MPN subtypes compared with expected survival in the general population, reflected in 10-year RSRs of 0.64 (95% CI, 0.62 to 0.67) in patients with PV, 0.68 (95% CI, 0.64 to 0.71) in those with ET, and 0.21 (95% CI, 0.18 to 0.25) in those with PMF. Excess mortality was observed in patients with any MPN subtype during all four calendar periods (P < .001). Survival improved significantly over time (P < .001); however, the improvement was less pronounced after the year 2000 and was confined to patients with PV and ET.ConclusionWe found patients with any MPN subtype to have significantly reduced life expectancy compared with the general population. The improvement over time is most likely explained by better overall clinical management of patients with MPN. The decreased life expectancy even in the most recent calendar period emphasizes the need for new treatment options for these patients.

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Emergency department use by pregnant women: A population-based study within a universal healthcare system

Journal of Obstetrics and Gynaecology Canada ◽

10.1016/j.jogc.2020.02.060 ◽

2020 ◽

Vol 42 (5) ◽

pp. 680

Author(s):

Darby Little ◽

Catherine Varner ◽

Alison Park ◽

Joel Ray

Keyword(s):

Emergency Department ◽

Pregnant Women ◽

Healthcare System ◽

Population Based ◽

Emergency Department Use ◽

Population Based Study ◽

Universal Healthcare ◽

Universal Healthcare System

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Trust in the Mass Media and the Healthcare System, Interpersonal Trust and Self-Rated Health: A Population-Based Study in Japan*

Asian Journal of Epidemiology ◽

10.3923/aje.2010.112.122 ◽

2010 ◽

Vol 3 (2) ◽

pp. 112-122

Author(s):

Yasuharu Tokuda ◽

Takashi Inoguchi

Keyword(s):

Mass Media ◽

Healthcare System ◽

Interpersonal Trust ◽

Population Based ◽

Population Based Study ◽

Self Rated Health ◽

The Mass Media

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Trends in disability of instrumental activities of daily living among older Chinese adults, 1997-2006: population based study

BMJ Open ◽

10.1136/bmjopen-2017-016996 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016996 ◽

Cited By ~ 12

Author(s):

Yajun Liang ◽

Anna-Karin Welmer ◽

Jette Möller ◽

Chengxuan Qiu

Keyword(s):

Daily Living ◽

Total Sample ◽

Population Based ◽

Chinese Adults ◽

Nutrition Survey ◽

Population Based Study ◽

Iadl Disability ◽

Older Chinese ◽

Older Chinese Adults ◽

Over Time

BackgroundData on trends for disability in instrumental activity of daily living (IADL) are sparse in older Chinese adults.ObjectivesTo assess trends in prevalence and incidence of IADL disability among older Chinese adults and to explore contributing factors.DesignPopulation based study.Setting15 provinces and municipalities in China.SubjectsParticipants (age ≥60) were from four waves of the China Health and Nutrition Survey, conducted in 1997 (n=1533), 2000 (n=1581), 2004 (n=2028) and 2006 (n=2256), and from two cohorts constructed within the national survey: cohort 1997–2004 (n=712) and cohort 2000–2006 (n=823).MeasurementsIADL disability was defined as inability to perform one or more of the following: shopping, cooking, using transportation, financing and telephoning. Data were analysed with logistic regression and generalised estimating equation models.ResultsThe prevalence of IADL disability significantly decreased from 1997 to 2006 in the total sample and in all of the subgroups by age, sex, living region and IADL items (all ptrend<0.05). The incidence of IADL disability remained stable from cohort 1997-2004 to cohort 2000-2006 in the total sample and in all of the subgroups (all p>0.10). The recovery rate from IADL disability significantly increased over time in those aged 60–69 years (p=0.03). Living in a rural area or access to local clinics for healthcare was less disabling over time (ptrend<0.02).ConclusionsThe prevalence of IADL disability decreased among older Chinese adults during 1997–2006, whereas the incidence remained stable. The declining prevalence of IADL disability might be partly due to the decreased duration of IADL disability, and to improvements in living conditions and healthcare facilities over time.

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